Multi-staged repair of contaminated primary and recurrent giant incisional herniae in the same hospital admission: A proposal for a new approach
| Autor: | A. K. Shrestha, Sanjoy Basu, Khurram Siddique |
|---|---|
| Jazyk: | angličtina |
| Předmět: |
Male
Reoperation medicine.medical_specialty Incisional hernia medicine.medical_treatment Operative Time Anastomosis Body Mass Index Postoperative Complications Recurrence Humans Surgical Wound Infection Medicine Hernia Staged repair Stage (cooking) Therapeutic Irrigation Prospective cohort study Herniorrhaphy Aged Retrospective Studies business.industry Abdominal Wall General Medicine Bowel resection Length of Stay Middle Aged Surgical Mesh Hernia repair medicine.disease Hernia Abdominal Surgery Hospital admission Female business Abdominal surgery |
| Zdroj: | International Journal of Surgery. (8):654 |
| ISSN: | 1743-9191 |
| DOI: | 10.1016/j.ijsu.2013.06.359 |
| Popis: | Repair of primary and recurrent giant incisional herniae is extremely challenging and more so in the face of surgical field contamination. Literature supports the single- and multi-staged approaches including the use of biological meshes for these difficult patients with their associated benefits and limitations.This is a retrospective analysis of a prospective study of five patients who were successfully treated through a multi-staged approach but in the same hospital admission, not previously described, for the repair of contaminated primary and recurrent giant incisional herniae in a district general hospital between 2009 and 2012. Patient demographics including their BMI and ASA, previous and current operative history including complications and follow-up were collected in a secure database. The first stage involved the eradication of contamination, and the second stage was the definitive hernia repair with the new generation-coated synthetic meshes.Of the five patients, three were men and two women with a mean age of 58 (45-74) years. Two patients had grade 4 while the remaining had grade 3 hernia as per the hernia grading system with a mean BMI of 35 (30-46). All patients required extensive adhesiolysis, bowel resection and anastomoses and wash out. Hernial defect was measured as 204* (105-440) cm(2), size of mesh implant was 568* (375-930) cm(2) and the total duration of operation (1st + 2nd Stage) was 354* (270-540) min. Duration of hospital stay was 11* (7-19) days with a follow-up of 17* (6-36) months.We believe that our multi-staged approach in the same hospital admission (for the repair of contaminated primary and recurrent giant incisional herniae), excludes the disadvantages of a true multi-staged approach and simultaneously minimises the risks and complications associated with a single-staged repair, can be adopted for these challenging patients for a successful outcome (* indicates mean). |
| Databáze: | OpenAIRE |
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